NEET-PG 2012 — Pediatrics
42 Previous Year Questions with Answers & Explanations
What is the most common presentation of tuberculosis (TB) in children?
What is the venous hematocrit level at which you will diagnose polycythemia in a newborn?
Neonatal conjunctivitis is caused by all of the following except:
Congenital varicella infection causes all except:
What is the RDA (Recommended Dietary Allowance) for vitamin A in infants aged 0-6 months?
An XX baby presenting with male genitalia (penis and scrotum) is likely due to which of the following conditions?
Rehydration therapy in a 2 year old severely dehydrated child is -
At what age do children typically begin to say short sentences of 4-5 words?
Rubella is known to cause all of the following conditions except:
Which of the following is a common symptom of neonatal lupus?
NEET-PG 2012 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1: What is the most common presentation of tuberculosis (TB) in children?
- A. Abscess
- B. Consolidation
- C. Hilar adenopathy (Correct Answer)
- D. CNS tuberculosis
Explanation: ***Hilar adenopathy*** - **Hilar adenopathy** is the most common radiographic finding in children with **primary tuberculosis**, reflecting lymph node involvement. - This is often accompanied by a small parenchymal lesion, forming the **Ghon complex**. *Abscess* - While TB can cause abscesses (e.g., cold abscesses in bone or soft tissue), it's not the **most common initial presentation** of primary childhood TB. - Abscess formation suggests a more **advanced or extrapulmonary** manifestation. *Consolidation* - **Consolidation** can be seen in adult-type or progressive primary TB, but it is less frequent than hilar adenopathy as the **initial presentation** in children. - It indicates **pneumonia-like changes** due to parenchymal inflammation. *CNS tuberculosis* - **Central Nervous System (CNS) tuberculosis** (e.g., tuberculous meningitis or tuberculoma) is a severe, extrapulmonary form of TB. - It is a **serious complication** rather than the most common initial presentation in children.
Question 2: What is the venous hematocrit level at which you will diagnose polycythemia in a newborn?
- A. 55%
- B. 60%
- C. 65% (Correct Answer)
- D. 70%
Explanation: ***Correct: 65%*** - **Polycythemia** in a newborn is typically diagnosed when the **venous hematocrit** is **≥65%**. - This threshold indicates an abnormally high concentration of **red blood cells**, increasing blood viscosity. *Incorrect: 55%* - A venous hematocrit of 55% is generally considered within the **normal range** for a newborn, especially within the first few hours of life. - It does not meet the criteria for diagnosing **polycythemia**. *Incorrect: 60%* - While 60% is elevated compared to adult norms, it is still generally within the higher end of the **normal range** for an infant. - This level alone is usually **not sufficient** to diagnose **polycythemia** or warrant intervention without other clinical signs. *Incorrect: 70%* - A venous hematocrit of 70% definitely indicates **polycythemia** and significant **hyperviscosity**. - However, the diagnostic threshold for polycythemia is **65%**, meaning the condition is identified earlier.
Question 3: Neonatal conjunctivitis is caused by all of the following except:
- A. Chlamydia
- B. Pseudomonas
- C. Aspergillus (Correct Answer)
- D. Gonococcus
Explanation: ***Aspergillus*** - **Fungal infections** of the eye, particularly by *Aspergillus*, are extremely rare in neonates and typically present as **keratitis** rather than conjunctivitis. - While *Aspergillus* can cause severe infections in immunocompromised individuals, it is not a common cause of neonatal conjunctivitis. *Gonococcus* - **_Neisseria gonorrhoeae_** is a well-known cause of **ophthalmia neonatorum** (gonococcal conjunctivitis), presenting as severe, purulent discharge usually within the first 2-5 days of life. - This infection can lead to **corneal ulceration** and blindness if untreated. *Chlamydia* - **_Chlamydia trachomatis_** is the most common bacterial cause of **neonatal conjunctivitis**, typically appearing 5-14 days after birth. - It causes a **mucopurulent discharge** and can be associated with **chlamydial pneumonia** in infants. *Pseudomonas* - **_Pseudomonas aeruginosa_** can cause severe and rapidly progressive **neonatal conjunctivitis** and **keratitis**, especially in premature infants or those exposed to contaminated solutions. - It is a highly aggressive pathogen that can lead to significant ocular morbidity.
Question 4: Congenital varicella infection causes all except:
- A. Macrocephaly (Correct Answer)
- B. Cortical atrophy
- C. Cicatrix
- D. Limb hypoplasia
Explanation: ***Macrocephaly*** - **Macrocephaly** is generally not a direct consequence of congenital varicella infection; rather, **microcephaly** due to brain damage is more commonly observed. - Congenital varicella typically causes destructive lesions leading to tissue loss, not increased head circumference. *Cortical atrophy* - **Cortical atrophy** results from the destructive effects of the virus on the developing brain, leading to **neuronal loss** and reduced brain volume. - This can manifest as **microcephaly**, an indirect but common finding associated with congenital varicella. *Cicatrix* - **Cicatrix** (zig-zag scarring) is a classic dermatological manifestation of congenital varicella, resulting from the virus's impact on developing skin. - These characteristic **skin lesions** are one of the most identifiable features of the syndrome. *Limb hypoplasia* - **Limb hypoplasia**, involving underdeveloped limbs, is a hallmark feature of congenital varicella, often due to **viral damage** to limb buds and associated neural structures. - This can lead to **bone shortening** and muscle atrophy in affected limbs.
Question 5: What is the RDA (Recommended Dietary Allowance) for vitamin A in infants aged 0-6 months?
- A. 400 mcg
- B. 600 mcg
- C. 800 mcg
- D. 350 mcg (Correct Answer)
Explanation: ***350 mcg*** - The **Recommended Dietary Allowance (RDA)** for vitamin A in infants aged 0-6 months is specifically set at **350 micrograms (mcg)** of **retinol activity equivalents (RAE)**. - This level is based on the **average vitamin A intake from human milk** during this period, assuming adequate maternal nutrition. *600 mcg* - This value is higher than the recommended intake for infants aged 0-6 months and is closer to the RDA for **older infants** or **young children**. - Excessive vitamin A intake can be **toxic**, making adherence to age-specific RDAs crucial. *800 mcg* - This amount is significantly higher than the RDA for infants 0-6 months and approaches the RDA for **adults**. - Providing such a high dose to an infant could lead to **vitamin A toxicity**, with symptoms including irritability, increased intracranial pressure, and desquamation of the skin. *400 mcg* - While closer to the correct answer, **400 mcg** is still slightly above the established RDA of 350 mcg for this specific age group. - The precise RDA values are determined based on **extensive research** to ensure optimal health outcomes without risk of deficiency or toxicity.
Question 6: An XX baby presenting with male genitalia (penis and scrotum) is likely due to which of the following conditions?
- A. Turner syndrome
- B. None of the options
- C. Klinefelter syndrome
- D. High level of testosterone in maternal blood (Correct Answer)
Explanation: ***High level of testosterone in maternal blood*** - An **XX baby** (genetically female) presenting with **fully masculinized external genitalia** (penis and scrotum) indicates significant **androgen exposure** during the critical period of sexual differentiation (8-12 weeks of gestation). - While the most common cause is **congenital adrenal hyperplasia (CAH)** due to fetal androgen excess, **maternal sources of androgens** can also cause complete masculinization. - Maternal causes include **virilizing tumors** (e.g., luteoma of pregnancy, Krukenberg tumor, arrhenoblastoma), **exogenous androgen administration**, or **maternal CAH**. - High sustained maternal testosterone crosses the placenta and causes **virilization of female fetus**, which can range from clitoromegaly to complete male phenotype. - This is the **only medically correct option** among the choices given, though CAH (not listed) would be the most common cause overall. *Klinefelter syndrome* - **47, XXY karyotype** - genetically male due to presence of Y chromosome with SRY gene. - Presents as phenotypic male, not relevant to an **XX individual**. - Features include hypogonadism, infertility, tall stature, and gynecomastia. *Turner syndrome* - **45, X karyotype** - monosomy X, genetically and phenotypically female. - Presents with **female external genitalia**, streak gonads, short stature, webbed neck. - Cannot explain masculinized genitalia in any scenario. *None of the options* - This is incorrect because **high level of testosterone in maternal blood** is a documented cause of XX virilization with male phenotype, though less common than fetal CAH.
Question 7: Rehydration therapy in a 2 year old severely dehydrated child is -
- A. 75 ml/kg in 4 hours
- B. 30 ml/kg in 1 hour, 70 ml/kg in 5 hours
- C. 20 ml/kg in 30 min, 80 ml/kg in 2.5 hours
- D. 30 ml/kg in 30 min, 70 ml/kg in 2.5 hours (Correct Answer)
Explanation: ***30 ml/kg in 30 min, 70 ml/kg in 2.5 hours*** - This option reflects the recommended rehydration protocol for a severely dehydrated child aged **12 months to 5 years**, where the first 30 ml/kg are given rapidly over 30 minutes, followed by 70 ml/kg over the next 2.5 hours. - This rapid initial infusion helps to quickly restore **circulating volume** and improve perfusion during severe dehydration. *30 ml/kg in 1 hour, 70 ml/kg in 5 hours* - This protocol is typically used for children with **some dehydration**, not severe dehydration, and is usually administered orally when possible. - The slower rate of rehydration would be insufficient for a severely dehydrated child requiring more urgent fluid replacement. *20 ml/kg in 30 min, 80 ml/kg in 2.5 hours* - While reflecting a rapid initial phase, the total volume and distribution of fluids differ from the WHO guidelines for **severe dehydration** in this age group. - The **initial 20 ml/kg over 30 minutes** is generally a slightly lower first bolus than recommended for very severe cases, and the subsequent phase is also adjusted. *75 ml/kg in 4 hours* - This represents a **lower total volume** (75 ml/kg compared to 100 ml/kg) and a different time distribution for severely dehydrated children in the 12 month to 5 year age group. - This protocol is more aligned with the management of **some dehydration** rather than the urgent requirements of severe dehydration.
Question 8: At what age do children typically begin to say short sentences of 4-5 words?
- A. 2 years
- B. 3 years
- C. 4 years (Correct Answer)
- D. 5 years
Explanation: ***4 years*** - By this age, children typically have a vocabulary of **1,500-2,500 words** and can construct sentences of **4-5 words**, demonstrating improved grammatical structure and complexity. - They can also tell simple stories and use pronouns and plurals correctly. *2 years* - Children at this age typically combine **two to three words** into short phrases, such as "more milk" or "daddy go." - Their vocabulary usually consists of about **50-200 words**, not enough for 4-5 word sentences. *3 years* - Three-year-olds usually speak in **three- to four-word sentences**, such as "I want big cookie." - Their vocabulary is typically around **900-1,000 words**, but they are still developing the complexity needed for consistent 4-5 word sentences. *5 years* - By age five, children can typically speak in much **longer and more complex sentences** (5-6+ words) and are mastering grammar rules. - They can comprehend and communicate more nuanced ideas, surpassing the milestone of 4-5 word sentences.
Question 9: Rubella is known to cause all of the following conditions except:
- A. Conduction defects
- B. VSD
- C. Microcephaly
- D. Glaucoma (Correct Answer)
Explanation: ***Glaucoma*** - While rubella can cause **ocular defects** such as **cataracts** and **pigmentary retinopathy**, glaucoma is not a typical congenital manifestation of rubella syndrome. - **Congenital glaucoma** is more commonly associated with other genetic syndromes or developmental anomalies. *Microcephaly* - **Microcephaly** is a recognized neurological complication of congenital rubella syndrome, resulting from impaired brain development due to viral infection. - The rubella virus can interfere with the **proliferation and migration** of neuronal cells during fetal development. *VSD* - **Ventricular septal defect (VSD)** is a common congenital heart defect associated with congenital rubella syndrome. - Other cardiac anomalies seen include **patent ductus arteriosus (PDA)** and **pulmonary artery stenosis**. *Conduction defects* - **Conduction defects** and other **cardiac arrhythmias** can occur in congenital rubella syndrome due to direct viral damage to the developing cardiac conduction system. - This can manifest as **bradyarrhythmias** or various degrees of **heart block**.
Question 10: Which of the following is a common symptom of neonatal lupus?
- A. All of the options
- B. Cutaneous lesion (Correct Answer)
- C. Thrombocytopenia
- D. Heart block
Explanation: ***Cutaneous lesion*** - **Cutaneous lesions** are the most common manifestation of neonatal lupus, typically appearing as an **annular erythematous rash** on the face and scalp. - These lesions often develop after exposure to **ultraviolet light** and usually resolve within 6 months as maternal autoantibodies clear from the infant's system. *Thrombocytopenia* - While **hematologic abnormalities** such as thrombocytopenia can occur in neonatal lupus, they are less common than cutaneous lesions. - **Thrombocytopenia** refers to a low platelet count, which can increase the risk of bleeding. *All of the options* - While all listed options (cutaneous lesions, thrombocytopenia, and heart block) can be features of neonatal lupus, **cutaneous lesions** are the most frequently observed symptom. - Choosing "All of the options" would imply equal commonality or presence of all in every case, which is not accurate. *Heart block* - **Congenital heart block** is a serious, but less common and often irreversible, manifestation of neonatal lupus, caused by maternal antibodies attacking the fetal cardiac conduction system. - It usually presents as **bradycardia** and may require a pacemaker, but it is not the most common symptom overall.